Guo Tian-Jiao, Qin Jin-Yu, Zhu Lin-Lin, Wang Jin, Yang Jin-Lin, Wang Yi-Ping
Tian-Jiao Guo, Jin-Yu Qin, Lin-Lin Zhu, Jin Wang, Jin-Lin Yang, Yi-Ping Wang, Gastroenterology Department of West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2015 Dec 21;21(47):13325-31. doi: 10.3748/wjg.v21.i47.13325.
To analyze the relationship between lymph node metastasis and clinical pathology of early gastric cancer (EGC) in order to provide criteria for a feasible endoscopic therapy.
Clinical data of the 525 EGC patients who underwent surgical operations between January 2009 and March 2014 in the West China Hospital of Sichuan University were analyzed retrospectively. Clinical pathological features were compared between different EGC patients with or without lymph node metastasis, and investigated by univariate and multivariate analyses for possible relationships with lymph node metastasis.
Of the 2913 patients who underwent gastrectomy with lymph node dissection, 529 cases were pathologically proven to be EGC and 525 cases were enrolled in this study, excluding 4 cases of gastric stump carcinoma. Among 233 patients with mucosal carcinoma, 43 (18.5%) had lymph node metastasis. Among 292 patients with submucosal carcinoma, 118 (40.4%) had lymph nodemetastasis. Univariate analysis showed that gender, tumor size, invasion depth, differentiation type and lymphatic involvement correlated with a high risk of lymph node metastasis. Multivariate analysis revealed that gender (OR = 1.649, 95%CI: 1.091-2.492, P = 0.018), tumor size (OR = 1.803, 95%CI: 1.201-2.706, P = 0.004), invasion depth (OR = 2.566, 95%CI: 1.671-3.941, P = 0.000), histological differentiation (OR = 2.621, 95%CI: 1.624-4.230, P = 0.000) and lymphatic involvement (OR = 3.505, 95%CI: 1.590-7.725, P = 0.002) were independent risk factors for lymph node metastasis. Comprehensive analysis showed that lymph node metastasis was absent in patients with tumor that was limited to the mucosa, size ≤ 2 cm, differentiated and without lymphatic involvement.
We propose an endoscopic therapy for EGC that is limited to the mucosa, size ≤ 2 cm, differentiated and without lymphatic involvement.
分析早期胃癌（EGC）淋巴结转移与临床病理之间的关系，以便为可行的内镜治疗提供标准。
回顾性分析2009年1月至2014年3月在四川大学华西医院接受手术的525例EGC患者的临床资料。比较不同有无淋巴结转移的EGC患者的临床病理特征，并通过单因素和多因素分析研究与淋巴结转移的可能关系。
在2913例行胃癌根治术并清扫淋巴结的患者中，529例经病理证实为EGC，525例纳入本研究，排除4例残胃癌。在233例黏膜癌患者中，43例（18.5%）有淋巴结转移。在292例黏膜下癌患者中，118例（40.4%）有淋巴结转移。单因素分析显示，性别、肿瘤大小、浸润深度、分化类型和淋巴管侵犯与淋巴结转移高风险相关。多因素分析显示，性别（OR = 1.649，95%CI：1.091 - 2.492，P = 0.018）、肿瘤大小（OR = 1.803，95%CI：1.201 - 2.706，P = 0.004）、浸润深度（OR = 2.566，95%CI：1.671 - 3.941，P = 0.000）、组织学分化（OR = 2.621，95%CI：1.624 - 4.230，P = 0.000）和淋巴管侵犯（OR = 3.505，95%CI：1.590 - 7.725，P = 0.002）是淋巴结转移的独立危险因素。综合分析显示，肿瘤局限于黏膜、大小≤2 cm、分化良好且无淋巴管侵犯的患者无淋巴结转移。
我们提出了一种针对局限于黏膜、大小≤2 cm、分化良好且无淋巴管侵犯的EGC的内镜治疗方法。
